J Clin Neurol.  2005 Apr;1(1):101-103. 10.3988/jcn.2005.1.1.101.

Wall-Eyed Monocular Internuclear Ophthalmoplegia (WEMINO) with Contraversive Ocular Tilt Reaction

• Jeon SB
• Chung SJ
• Ahn H
• Lee JH
• Jung JM
• Lee MC

• KMID: 2287720
• DOI: http://doi.org/10.3988/jcn.2005.1.1.101

Abstract

Wall-eyed monocular internuclear ophthalmoplegia (WEMINO) with contraversive ocular tilt reaction has not been previously reported. A 71-year-old woman suddenly developed blurred vision. Examination revealed left internuclear ophthalmoplegia, left exotropia, right hypotropia, and rightward head tilt. Magnetic resonance imaging showed a tiny infarction at the area of the left medial longitudinal fasciculus in the upper pons. WEMINO with contraversive ocular tilt reaction may be caused by a paramedian pontine tegmental infarction that selectively involves the medial longitudinal fasciculus.

Keyword

Wall-eyed monocular internuclear ophthalmoplegia (WEMINO); Internuclear ophthalmoplegia; Ocular tilt reaction

MeSH Terms

Aged
Exotropia
Female
Head
Humans
Infarction
Magnetic Resonance Imaging
Ocular Motility Disorders*
Pons

Reference

1. Brazis PW, Masdeu JC, Biller J. Ocular motor system. Localization in clinical neurology. 2001. 4th ed. Philadelphia: Lippincott Williams & Wilkins;171–270.

2. Johnston JL, Sharpe JA. The WEMINO syndrome-wall-eyed monocular internuclear ophthalmoplegia: An oculographic and neuropathologic characterization. Neurology. 1994. 44:suppl 2. A311.

3. Ikeda Y, Okamoto K. Lesion responsible for WEMINO syndrome confirmed by magnetic resonance imaging. J Neurol Neurosurg Psychiatry. 2002. 73:204–209.

4. Brandt T, Dieterich M. Vestibular syndromes in the roll plane: topographic diagnosis from brainstem to cortex. Ann Neurol. 1994. 36:337–347.

5. Gacek RR. Location of brain stem neurons projecting to the oculomotor nucleus in the cat. Exp Neurol. 1977. 57:725–749.

6. Komiyama A, Takamatsu K, Johkura K, Hasegawa O, Fukutake T, Hirayama K. Internuclear ophthalmoplegia and contralateral exotropia: Nonparalytic pontine exotropia and WEBINO syndrome. Neuro-ophthalmology. 1998. 19:33–44.